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Iron

Xervier had terrible troubles with sleep for the first 18 months of his life even though he did not have apnea or snoring.  At 18 months we supplemented Xervier with iron due to very low values on his iron studies (blood tests).  His iron levels slowly came up.  What we didn't associate with this at the time was the improvement in Xervier's sleep at the same time.  When Xervier was 2 years old we attended a talk by a sleep paediatrician and he spoke about the importance of iron levels to good sleep in all children (and adults).  This is when the penny dropped and we realised what had improved Xervier's sleep!  Iron is often seen as a problem area for children with DS - people are afraid to supplement with it because of the oxidative load it carries, however ...

Both the paediatric sleep physician and a paediatric gastroenterologist that we consult with strongly recommend supplementing with iron for sleep disturbances in children IF A FERRITIN LEVEL LESS THAN 50 mcg/L IS SHOWN.  The "normal" range is 20 - 200 mcg/L.   NB. mcg/L = ng/mL (used in the USA).

Ferritin is the iron storage molecule of the body.  In children with DS iron supplementation should only be undertaken if low iron levels are proven and they should be monitored regularly during supplementation so that the supplement can be stopped ASAP.
 
An iron supplement that we are very pleased with is Spatone.  It is in a liquid form, tastes great and seems to be very easily absorbed, even in patients who have previously responded poorly to iron pills.  We used half a sachet per day with our 10kg son.  Putting it in orange, apple or pineapple juice improves absorption due to the presence of vitamin C.  Don't take it close to calcium (eg milk) or zinc supplements.  You would need your doctors advice for children under the age of 2.  Technical data is attached below.
http://www.spatone.com/shop-online/

In the US ordering several packs will get you free postage.  For details contact:

David Kuykendall
mailto:DavidKuykendall@nelsons.net
Customer Service & Sales Support Manager
Nelsons USA
t: 800-319-9151 ext. 140
f: 978-988-0233
www.nelsonsnaturalworld.com


See detailed information on Iron Deficiency Anaemia


Research regarding sleep and ferritin:
 
Eur Child Adolesc Psychiatry. 2009 Jul;18(7):393-9. Epub 2009 Feb 5.
Sleep disturbances and serum ferritin levels in children with attention-deficit/hyperactivity disorder.
 
Cortese S, Konofal E, Bernardina BD, Mouren MC, Lecendreux M.
 
AP-HP, Child and Adolescent Psychopathology Unit, Robert Debré Hospital, Paris VII University, Paris, France. samuele.cortese@...
 
BACKGROUND: A subset of children with attention-deficit/hyperactivity disorder (ADHD) may present with impairing sleep disturbances. While preliminary evidence suggests that iron deficiency might be involved into the pathophysiology of daytime ADHD symptoms, no research has been conducted to explore the relationship between iron deficiency and sleep disturbances in patients with ADHD. The aim of this study was to assess the association between serum ferritin levels and parent reports of sleep disturbances in a sample of children with
ADHD. 
METHODS: Subjects: Sixty-eight consecutively referred children (6-14 years) with ADHD diagnosed according to DSM-IV criteria using the semi-structured interview Kiddie-SADS-PL. Measures: parents filled out the Sleep Disturbance Scale for Children (SDSC) and the Conners Parent Rating Scale (CPRS). Serum ferritin levels were determined using the Tinaquant method.
RESULTS: Compared to children with serum ferritin levels >or=45 microg/l, those with serum ferritin levels <45 microg/l had significantly higher scores on the SDSC subscale "Sleep wake transition disorders" (SWTD) (P = 0.042), which includes items on abnormal movements in sleep, as well as significantly higher scores on the CPRS-ADHD index (P = 0.034). The mean scores on the other SDSC subscales did not significantly differ between children with serum ferritin >or=45 and <45 microg/l. Serum ferritin levels were inversely correlated to SWTD scores (P = 0.043). CONCLUSION: Serum ferritin levels <45 microg/l might indicate a risk for sleep wake transition disorders, including abnormal sleep movements, in children with ADHD. Our results based on questionnaires set the basis for further actigraphic and polysomnographic studies on nighttime activity and iron deficiency in ADHD. Research in this field may suggest future trials of iron supplementation (possibly in association with ADHD medications) for abnormal sleep motor activity in children with ADHD.
 
PMID: 19205783 [PubMed - indexed for MEDLINE]
 

Sleep. 2003 Sep;26(6):735-8.
Periodic limb movements in sleep and iron status in children.
 
Simakajornboon N, Gozal D, Vlasic V, Mack C, Sharon D, McGinley BM.
 
Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA. nsimaka@...
 
Comment in:
 
* Sleep Med. 2004 Jan;5(1):89-90.
 
STUDY OBJECTIVES: To assess potential relationships between serum iron and ferritin levels and the severity of periodic limb movement in sleep (PLMS) in a pediatric population, and to evaluate the response to supplemental iron therapy.
DESIGN: A prospective study of all consecutively diagnosed children with PLMS (periodic limb movement index [periodic limb movements per hour of total sleep time, [PLMI] > 5) who underwent overnight polysomnographic evaluation. In all patients, complete blood count and serum iron and ferritin levels were obtained. Patients with serum ferritin concentrations less than 50 microg/L were prescribed iron sulfate at 3 mg/kg of elemental iron per day for 3 months. At the end of treatment, serum iron and ferritin levels and sleep studies were
repeated. SETTING: Comprehensive Sleep Medicine Center, Tulane University Health Sciences Center, and Kosair Children's Hospital Sleep Medicine and Apnea Center.
PATIENTS: Twenty boys and 19 girls with PLMS with a mean age of 7.5 +/- 3.1 years. 
INTERVENTION: Iron therapy. RESULTS: Twenty-eight (71.8%) patients had ferritin levels less than 50 microg/L. There was no significant correlation between serum ferritin concentration and PLMS severity as indicated by the PLMI (r = -0.19). The PLMI in patients with serum ferritin levels less than 50 microg/L (29.9 +/- 15.5 PLM/h) was higher than in patients with serum ferritin levels greater than 50 microg/L (21.9 +/- 11.8 PLM/h); however, the difference did not achieve statistical significance (P = 0.09). In contrast, serum iron was significantly correlated with PLMI (r = -0.43, P < 0.01). Indeed, patients with serum iron concentrations less than 50 microg/dL had a higher PLMI compared to patients with serum iron concentrations greater than 50 microg/dL (42.8 +/- 18.3 PLM/h and 23.1 +/- 10.1 PLM/h, respectively; P = 0.02). Twenty-five out of the 28 PLMS patients with serum ferritin levels less than 50 microg/L received treatment with iron sulfate, and 19 (76%) responded favorably. Among the responders to iron therapy, PLMI decreased from 27.6 +/- 14.9 PLM per hour to 12.6 +/- 5.3 PLM per hour after 3 months of iron supplements (P < 0.001) and coincided with increases in serum ferritin levels (pre: 40.8 +/- 27.4 microg/L vs post: 74.1 +/- 13.0 microg/L; P < 0.001). CONCLUSIONS: In children, the presence of PLMS is frequently associated with low serum iron and a tendency toward low serum ferritin levels. In addition, iron therapy is associated with clinical improvement in most of these patients.
 
PMID: 14572128 [PubMed - indexed for MEDLINE]
 
 
Pediatric Nuerology Volume 36, Issue 3, Pages 152-158 (March 2007)
 
Children With Autism: Effect of Iron Supplementation on Sleep and Ferritin
 
Cara F. Dosman, MDCorresponding Author Informationemail address, Jessica A.
Brian, PhD†, Irene E. Drmic, MSc‡, Ambikaipakan Senthilselvan, PhD§, Mary M.
Harford, RN†, Ryan W. Smith†, Waseem Sharieff, MD, PhD&#8741;¶, Stanley H.
Zlotkin, MD&#8741;, Harvey Moldofsky, MD#, S. Wendy Roberts, MD†
 
To determine if there is a relationship between low serum ferritin and sleep disturbance in children with autism spectrum disorder, an 8-week open-label treatment trial with oral iron supplementation was conducted as a pilot study. At baseline and post-treatment visits, parents completed a Sleep Disturbance Scale for Children and a Food Record. Blood samples were obtained. Thirty-three children completed the study. Seventy-seven percent had restless sleep at baseline, which improved significantly with iron therapy, suggesting a relationship between sleep disturbance and iron deficiency in children with autism spectrum disorder. Sixty-nine percent of preschoolers and 35% of
school-aged children had insufficient dietary iron intake. Mean ferritin increased significantly (16 &#956;g/L to 29 &#956;g/L), as did mean corpuscular volume and hemoglobin, suggesting that low ferritin in this patient group resulted from insufficient iron intake. Similar prevalence of low ferritin at school age as preschool age indicates that children with autism spectrum disorder require ongoing screening for iron deficiency.
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Paul Doney,
18 Nov 2009 14:51
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